ISSN 1671-5411 CN 11-5329/R
Jordan Laggoune, Nitesh Nerlekar, Kiran Munnur, Brian SH Ko, James D Cameron1, Sujith Seneviratne, Dennis TL Wong. The utility of coronary computed tomography angiography in elderly patients. J Geriatr Cardiol 2019; 16(7): 507-513. doi: 10.11909/j.issn.1671-5411.2019.07.006
Citation: Jordan Laggoune, Nitesh Nerlekar, Kiran Munnur, Brian SH Ko, James D Cameron1, Sujith Seneviratne, Dennis TL Wong. The utility of coronary computed tomography angiography in elderly patients. J Geriatr Cardiol 2019; 16(7): 507-513. doi: 10.11909/j.issn.1671-5411.2019.07.006

The utility of coronary computed tomography angiography in elderly patients

doi: 10.11909/j.issn.1671-5411.2019.07.006
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  • Received Date: 2019-06-24
  • Rev Recd Date: 2019-06-24
  • Publish Date: 2019-07-28
  • Background Coronary computed tomography angiography (CCTA) is often avoided in elderly patients due to a presumption that a high proportion of patients will have heavily calcified plaque limiting an accurate assessment. We sought to assess the image quality, luminal stenosis and utility of CCTA in elderly patients with suspected coronary artery disease (CAD) and stable chest pain. Methods Retrospective analysis of elderly patients (> 75 years) who underwent 320-detector row CCTA between 2012–2017 at MonashHeart. The CCTA was analysed for degree maximal coronary stenosis by CAD-RADS classification, image quality by a 5-point Likert score (1-poor, 2-adequate, 3-good, 4-very good, 5-excellent) and presence of artefact limiting interpretability. Results 1011 elderly patients (62% females, 78.8 ± 3.3 years) were studied. Cardiovascular risk factor prevalence included: hypertension (65%), hyperlipidaemia (48%), diabetes (19%) and smoking (21%). The CCTA was evaluable in 68% of patients which included 52% with non-obstructive CAD ( 50%) stenosis. Mean Likert score was 3.1 ± 0.6 corresponding to good image quality. Of the 323 (32%) of patients with a non-interpretable CCTA, 80% were due to calcified plaque and 20% due to motion artefact. Male gender (P = 0.009), age (P = 0.02), excess motion (P P = 0.03) were associated with non-interpretable CCTA. Conclusion Although CCTA is a feasible non-invasive tool for assessment of elderly patients with stable chest pain, clinicians should still be cautious about referring elderly patients for CCTA. Patients who are male, diabetic and >78 years of age are significantly less likely to have interpretable scans.
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